Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.196
Filtrar
1.
Medicine (Baltimore) ; 99(14): e19600, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243382

RESUMO

Slipped capital femoral epiphysis (SCFE) is a very common disorder affecting the adolescent hip. The etiology of SCFE is multifactorial and mechanical force associated with the characteristic morphology of the hip is considered one of the causes of SCFE. We investigated the characteristics of whole pelvic morphology including pelvic incidence (PI) in patients with SCFE and compared it with pelvic morphology in healthy children. We retrospectively assessed the whole pelvic morphology of 17 patients with SCFE and 51 healthy children using their pelvic computed tomography data. We measured superior iliac angle, inferior iliac angle, and ischiopubic angle as the parameters of pelvic rotation. Additionally, we measured acetabular anteversion of the superior acetabulum (AVsup) and of the center of the acetabulum (AVcen), and measured anterior acetabular sector angle (AASA), posterior acetabular sector angle, and the superior acetabular sector angle (SASA) as parameters of acetabular coverage and PI. Each measurement was compared between the 2 groups. AASA and SASA of patients with SCFE were significantly greater than that of controls, and AVsup of patients with SCFE was significantly smaller. There were no significant differences in pelvic rotation, PI, or AVcen between the 2 groups. This is the 1st report to evaluate SCFE patients' whole pelvic morphology including PI and pelvic rotation. Our results showed that patients with SCFE have excessive coverage of the anterior and superior acetabulum, and a more retroverted cranial acetabulum as compared with healthy control subjects. Such characteristic pelvic morphology may be involved in the onset of SCFE. To clarify the mechanical forces involved in SCFE onset, further investigations of pelvic morphology and alignment, including the femur and spine, are needed.


Assuntos
Acetábulo/patologia , Pelve/patologia , Escorregamento das Epífises Proximais do Fêmur/patologia , Tomografia Computadorizada por Raios X , Acetábulo/diagnóstico por imagem , Adolescente , Criança , Feminino , Humanos , Masculino , Pelve/diagnóstico por imagem , Estudos Retrospectivos , Escorregamento das Epífises Proximais do Fêmur/diagnóstico por imagem
2.
Can Assoc Radiol J ; 71(1): 19-29, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32063003

RESUMO

The presence of intralesional fat provides an invaluable tool for narrowing the differential diagnosis for both benign and malignant neoplasms of the abdomen and pelvis. The ability to characterize intralesional fat is further expanded by the ability of magnetic resonance imaging to detect small quantities (intravoxel) of fat. While the presence of intralesional fat can help to provide a relatively narrow set of diagnostic possibilities, depending on the type of fat (macroscopic vs intravoxel) that is present and the organ of origin, radiologists must be aware of uncommon mimickers of pathology, both benign and malignant.


Assuntos
Abdome/diagnóstico por imagem , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/patologia , Neoplasias/diagnóstico por imagem , Pelve/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X
3.
Can Assoc Radiol J ; 71(2): 231-237, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32062986

RESUMO

PURPOSE: This study aims to evaluate the overall diagnostic accuracy of preoperative multidetector computed tomography (MDCT) in penetrating abdominal and pelvic injuries (PAPI). METHOD AND MATERIALS: We used our hospitals' trauma registry to retrospectively identify patients with PAPI from January 1, 2006, to December 31, 2016. Only patients who had a 64-MDCT scan at presentation and subsequently underwent laparotomy or laparoscopy were included in our study cohort. Each finding noted on MDCT was rated using a 5-point scale to indicate certainty of injury, with a score of 0 being definitive. Using surgical findings as the gold standard, the accuracy of radiology reports was analyzed in 2 ways. A κ statistic was calculated to evaluate each pair of values for absolute agreement, and ratings for all organ systems were analyzed using a repeated measures analysis of variance (ANOVA) to determine whether radiology and surgical findings were similar enough to be clinically meaningful. Qualitative review of the radiology and surgical reports focused on the gastrointestinal (GI) tract was conducted. RESULTS: Our cohort consisted of 38 males and 4 females with a median age of 29 years and a median injury severity score of 15.6. For this study, 12 different organ groups were categorized and analyzed. Of those organ groups, absolute agreement between MDCT and surgical findings was found only for liver and spleen (κ values ranging from 0.2 to 0.5). Additionally, the ANOVA revealed an interaction between finding type and organ system (F 1, 33 = 7.4, P < .001). The most clinically significant discrepancies between MDCT and surgical findings were for gallbladder, bowel, mesenteric, and diaphragmatic injuries. Qualitative review of the GI tract revealed that radiologists can detect significant findings such as presence of injury, however, localization and extent of injury pose a challenge. CONCLUSION: The detection of clinically significant injuries to solid organs in trauma patients with PAPI on 64-MDCT is adequate. However, detection of injury to the remaining organ groups on MDCT, especially bowel, mesentery, and diaphragm, remains a challenge.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Sistema Digestório/diagnóstico por imagem , Sistema Digestório/lesões , Tomografia Computadorizada Multidetectores , Pelve/lesões , Ferimentos Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Idoso , Diafragma/diagnóstico por imagem , Diafragma/lesões , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/lesões , Humanos , Escala de Gravidade do Ferimento , Intestinos/diagnóstico por imagem , Intestinos/lesões , Fígado/diagnóstico por imagem , Fígado/lesões , Masculino , Mesentério/diagnóstico por imagem , Mesentério/lesões , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Pelve/cirurgia , Período Pré-Operatório , Estudos Retrospectivos , Sensibilidade e Especificidade , Baço/diagnóstico por imagem , Baço/lesões , Ferimentos Penetrantes/cirurgia , Adulto Jovem
4.
Radiol Clin North Am ; 58(2): 199-213, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044002

RESUMO

This article discusses the 4 main imaging modalities used to evaluate reproductive-aged women: ultrasound, magnetic resonance imaging, computed tomography, and fluoroscopy. For each modality, major clinical indications are described, along with important technical considerations unique to imaging reproductive-aged women. Finally, key safety issues are discussed, particularly with regard to imaging pregnant patients.


Assuntos
Imagem por Ressonância Magnética/métodos , Pelve/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Adulto , Feminino , Fluoroscopia/efeitos adversos , Fluoroscopia/métodos , Humanos , Imagem por Ressonância Magnética/efeitos adversos , Órgãos em Risco , Tomografia Computadorizada por Raios X/efeitos adversos , Ultrassonografia/efeitos adversos
5.
Radiol Clin North Am ; 58(2): 329-345, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044010

RESUMO

Acute pelvic pain in the nonpregnant woman is one of the most common conditions requiring emergent medical evaluation in routine clinical practice. Although clinical evaluation and laboratory testing are essential, imaging plays a central role. Although various adnexal and uterine disorders may result in acute pelvic pain of gynecologic origin, other nongynecologic disorders of the gastrointestinal and genitourinary systems may likewise result in acute pelvic pain. Ultrasound is first choice for initial evaluation of acute pelvic pain of gynecologic origin. Computed tomography is performed if pelvic sonography is inconclusive, or if a suspected disorder is nongynecologic in origin.


Assuntos
Dor Aguda/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Dor Pélvica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Feminino , Humanos , Pelve/diagnóstico por imagem
6.
Radiol Clin North Am ; 58(2): 363-380, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044012

RESUMO

Abdominal pain is a common occurrence in pregnant women and may have a variety of causes, including those that are specific to pregnancy (eg, round ligament pain in the first trimester) and the wide range of causes of abdominal pain that affect men and women who are not pregnant (eg, appendicitis, acute cholecystitis). Noncontrast magnetic resonance (MR) imaging is increasingly performed to evaluate pregnant women with abdominal pain, either as the first-line test or as a second test following ultrasonography. The imaging appearance of causes of abdominal pain in pregnant women are reviewed with an emphasis on noncontrast MR imaging.


Assuntos
Abdome Agudo/diagnóstico por imagem , Dor Aguda/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Complicações na Gravidez/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Pelve/diagnóstico por imagem , Gravidez
7.
PLoS One ; 15(1): e0228424, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31999774

RESUMO

OBJECTIVE: To identify the whole-body MRI (WB-MRI) image type(s) with the highest value for assessment of multiple myeloma, in order to optimise acquisition protocols and read times. METHODS: Thirty patients with clinically-suspected MM underwent WB-MRI at 3 Tesla. Unenhanced Dixon images [fat-only (FO) and water-only (WO)], post contrast Dixon [fat-only plus contrast (FOC) and water-only plus contrast (WOC)] and diffusion weighted images (DWI) of the pelvis from all 30 patients were randomised and read by three experienced readers. For each image type, each reader identified and labelled all visible myeloma lesions. Each identified lesion was compared with a composite reference standard achieved by review of a complete imaging dataset by a further experienced consultant radiologist to determine truly positive lesions. Lesion count, true positives, sensitivity, and positive predictive value were determined. Time to read each scan set was recorded. Confidence for a diagnosis of myeloma was scored using a Likert scale. Conspicuity of focal lesions was assessed in terms of percent contrast and contrast to noise ratio (CNR). RESULTS: Lesion count, true positives, sensitivity and confidence scores were significantly higher when compared to other image types for DWI (P<0.0001 to 0.003), followed by WOC (significant for sensitivity (P<0.0001 to 0.004), true positives (P = 0.003 to 0.049) and positive predictive value (P< 0.0001 to 0.006)). There was no statistically significant difference in these metrics between FO and FOC. Percent contrast was highest for WOC (P = 0.001 to 0.005) and contrast to noise ratio (CNR) was highest for DWI (P = 0.03 to 0.05). Reading times were fastest for DWI across all observers (P< 0.0001 to 0.014). DISCUSSION: Observers detected more myeloma lesions on DWI images and WOC images when compared to other image types. We suggest that these image types should be read preferentially by radiologists to improve diagnostic accuracy and reporting efficiency.


Assuntos
Interpretação de Imagem Assistida por Computador/normas , Mieloma Múltiplo/diagnóstico por imagem , Imagem Corporal Total/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Distribuição Aleatória , Sensibilidade e Especificidade
8.
AJR Am J Roentgenol ; 214(3): 636-640, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31939701

RESUMO

OBJECTIVE. A common goal in patients with newly discovered brain lesions is to determine if the lesions are primary malignant brain neoplasms, metastases, or benign entities. Such patients often undergo CT of the chest, abdomen, and pelvis (CT CAP) to identify a primary neoplasm that may have metastasized to the brain. The aim of this study is to determine the frequency of finding a primary cancer on CT CAP. MATERIALS AND METHODS. A large academic hospital imaging database was searched for cases of new intracranial lesions with subsequent CT CAP performed for metastatic workup. The frequency of primary neoplasms diagnosed in the chest versus abdominal and pelvic portions of CT scans was determined in patients with newly identified intraaxial and extraaxial brain lesions. Lesion characteristics were recorded including size, number, and the presence of enhancement and hemorrhage. Ancillary signs of an abdominopelvic neoplasm were also recorded. RESULTS. A total of 227 of 287 (79%) cases of newly discovered intracranial lesions were malignant (primary or metastatic) and 60 (21%) were benign. Of the 227 malignant cases, 136 (60%) were primary brain neoplasms and 91 (40%) were brain metastases, and 68 of the 91 (75%) lung primary. Chest CT (CTC) identified a primary neoplasm in 65 of 287 (23%) cases; 63 of those 65 (96%) neoplasms arose in the lungs. CT of the abdomen and pelvis (CTAP) identified a primary neoplasm in only 3 of 287 (1%) cases. In 26 cases in which the intracranial lesions did not enhance, only one was metastatic. CONCLUSION. In patients with newly discovered brain lesions, CTC is warranted, but CTAP is unlikely to be useful in patients without ancillary signs of abdominopelvic neoplasm.


Assuntos
Cavidade Abdominal/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Metástase Neoplásica/diagnóstico por imagem , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Pelve/diagnóstico por imagem , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Radiol Med ; 125(2): 157-164, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31591701

RESUMO

PURPOSE: MR-guided radiotherapy (MRgRT) relies on the daily assignment of a relative electron density (RED) map to allow the fraction specific dose calculation. One approach to assign the RED map consists of segmenting the daily magnetic resonance image into five different density levels and assigning a RED bulk value to each level to generate a synthetic CT (sCT). The aim of this study is to evaluate the dose calculation accuracy of this approach for applications in MRgRT. METHODS: A planning CT (pCT) was acquired for 26 patients with abdominal and pelvic lesions and segmented in five levels similar to an online approach: air, lung, fat, soft tissue and bone. For each patient, the median RED value was calculated for fat, soft tissue and bone. Two sCTs were generated assigning different bulk values to the segmented levels on pCT: The sCTICRU uses the RED values recommended by ICRU46, and the sCTtailor uses the median patient-specific RED values. The same treatment plan was calculated on two the sCTs and the pCT. The dose calculation accuracy was investigated in terms of gamma analysis and dose volume histogram parameters. RESULTS: Good agreement was found between dose calculated on sCTs and pCT (gamma passing rate 1%/1 mm equal to 91.2% ± 6.9% for sCTICRU and 93.7% ± 5.3% b or sCTtailor). The mean difference in estimating V95 (PTV) was equal to 0.2% using sCTtailor and 1.2% using sCTICRU, respect to pCT values CONCLUSIONS: The bulk sCT guarantees a high level of dose calculation accuracy also in presence of magnetic field, making this approach suitable to MRgRT. This accuracy can be improved by using patient-specific RED values.


Assuntos
Abdome/diagnóstico por imagem , Imagem por Ressonância Magnética , Pelve/diagnóstico por imagem , Radioterapia Guiada por Imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador
10.
Eur Radiol ; 30(1): 328-336, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31332559

RESUMO

OBJECTIVES: Despite the advantages of prostate-specific membrane antigen (PSMA)-PET/MR over PSMA-PET/CT, its relatively long scanning time and suboptimal PET attenuation correction necessitate careful assessment of the most appropriate setting for this type of study. We assessed lesion agreement between PSMA-PET/MR and PSMA-PET/CT in patients undergoing initial evaluation of prostate cancer. METHODS: This was a prospective study of consecutive patients with histological biopsy-proven prostate cancer who underwent pelvic PSMA-PET/MR followed by whole-body PSMA-PET/CT. All conspicuous PSMA-avid foci were counted on PSMA-PET/CT and PSMA-PET/MR with CT or MR correlation. Analysis was performed for intra-prostatic lesions, capsular invasion, seminal vesicle involvement and lymph node and bone involvement. Incidental and significant findings seen on PSMA-PET/CT outside the PSMA-PET/MR field of view were also analysed. Agreements between PSMA-PET/CT and PSMA-PET/MR findings were performed using Cohen's kappa test. RESULTS: Image analysis was performed on 140 patients (mean age, 67.3 ± 8.2 years). Agreement between PSMA PET/CT and PSMA-PET/MR was very good for intra-prostatic PSMA-avid foci (K = 0.85) and pelvic lymph nodes (K = 0.98), good for PSMA-avid bone metastases (K = 0.76) and fair for prostatic capsular invasion (K = 0.25) and seminal vesicle involvement (K = 0.31). Twelve patients (8.5%) had incidental findings and two patients (1.4%) had clinically significant findings. CONCLUSION: Limited pelvic PSMA-PET/MR has very good agreement with PET/CT regarding PSMA-avid prostatic, regional lymph nodes and bone lesions, and is superior to PET/CT with regard to capsular invasion and seminal vesicle involvement. KEY POINTS: • Limited pelvic PSMA-PET/MR is superior to whole-body PSMA-PET/CT in detecting extensions of localised disease, mainly due to the high soft tissue resolution of MR. • Limited pelvic PSMA-PET/MR may be useful for initial evaluation of histological biopsy-proven prostate cancer. • Further studies are warranted to evaluate limited pelvic PSMA-PET/MR for screening and active surveillance in selected populations.


Assuntos
Antígenos de Superfície , Glutamato Carboxipeptidase II , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons/métodos , Neoplasias da Próstata/diagnóstico por imagem , Idoso , Biópsia , Neoplasias Ósseas/secundário , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Pelve/diagnóstico por imagem , Pelve/patologia , Estudo de Prova de Conceito , Estudos Prospectivos , Neoplasias da Próstata/patologia , Glândulas Seminais/patologia
11.
Medicine (Baltimore) ; 98(52): e18500, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876738

RESUMO

Developmental dysplasia of the hip (DDH) is common, and features a widened Sharp's angle as observed on pelvic x-ray images. Determination of Sharp's angle, essential for clinical decisions, can overwhelm the workload of orthopedic surgeons. To aid diagnosis of DDH and reduce false negative diagnoses, a simple and cost-effective tool is proposed. The model was designed using artificial intelligence (AI), and evaluated for its ability to screen anteroposterior pelvic radiographs automatically, accurately, and efficiently.Orthotopic anterior pelvic x-ray images were retrospectively collected (n = 11574) from the PACS (Picture Archiving and Communication System) database at Second Hospital of Jilin University. The Mask regional convolutional neural network (R-CNN) model was utilized and finely modified to detect 4 key points that delineate Sharp's angle. Of these images, 11,473 were randomly selected, labeled, and used to train and validate the modified Mask R-CNN model. A test dataset comprised the remaining 101 images. Python-based utility software was applied to draw and calculate Sharp's angle automatically. The diagnoses of DDH obtained via the model or the traditional manual drawings of 3 orthopedic surgeons were compared, each based on the degree of Sharp's angle, and these were then evaluated relative to the final clinical diagnoses (based on medical history, symptoms, signs, x-ray films, and computed tomography images).Sharp's angles on the left and right measured via the AI model (40.07°â€Š±â€Š4.09° and 40.65°â€Š±â€Š4.21°), were statistically similar to that of the surgeons' (39.35°â€Š±â€Š6.74° and 39.82°â€Š±â€Š6.99°). The measurement time required by the AI model (1.11 ±â€Š0.00 s) was significantly less than that of the doctors (86.72 ±â€Š1.10, 93.26 ±â€Š1.12, and 87.34 ±â€Š0.80 s). The diagnostic sensitivity, specificity, and accuracy of the AI method for diagnosis of DDH were similar to that of the orthopedic surgeons; the diagnoses of both were moderately consistent with the final clinical diagnosis.The proposed AI model can automatically measure Sharp's angle with a performance similar to that of orthopedic surgeons, but requires far less time. The AI model may be a viable auxiliary to clinical diagnosis of DDH.


Assuntos
Luxação Congênita de Quadril/diagnóstico por imagem , Pelve/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Inteligência Artificial , Criança , Luxação Congênita de Quadril/diagnóstico , Humanos , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Radiografia/métodos , Estudos Retrospectivos , Adulto Jovem
12.
Medicine (Baltimore) ; 98(41): e17565, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593140

RESUMO

RATIONALE: Invasive moles occur in the fertile period, with about 95% occurring after previous mole removal and the remaining 5% occurring after several other pregnancies. PATIENT CONCERNS: A 27-year-old patient developed a rare invasive mole two months after a missed abortion. DIAGNOSES: A transvaginal ultrasound scan revealed a 3.6 × 2.9 × 2.4 cm sized lesion with cystic vascular areas within it, within the myometrium of the right fundal posterior region of the uterus. There was no metastasis to other organs. INTERVENTIONS: After administration of methotrexate, the level of beta-human chorionic gonadotropin (ß-hCG) was elevated and liver enzymes were also markedly elevated. She wanted to retain fertility for future pregnancies. After laparoscopic removal of the myometrial invasive mole, the incision site was sutured with a 3-0 V-Loc. OUTCOMES: One year later, a natural pregnancy occurred and a cesarean section was performed at 36 weeks. LESSONS: This is the first reported case of its type. Our case demonstrated that pelviscopic removal of an invasive mole is possible if there are no other metastases, and that future pregnancy and childbirth are still feasible in women of reproductive age.


Assuntos
Mola Hidatiforme Invasiva/cirurgia , Miométrio/cirurgia , Pelve/diagnóstico por imagem , Neoplasias Uterinas/cirurgia , Adulto , Gonadotropina Coriônica/análise , Feminino , Humanos , Mola Hidatiforme Invasiva/diagnóstico por imagem , Mola Hidatiforme Invasiva/patologia , Laparoscopia/métodos , Metotrexato/administração & dosagem , Miométrio/patologia , Gravidez , Resultado do Tratamento , Ultrassonografia/métodos , Neoplasias Uterinas/patologia
13.
Dis Colon Rectum ; 62(11): 1326-1335, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31567929

RESUMO

BACKGROUND: We demonstrated previously that radiation proctitis induced by preoperative radiotherapy is a predisposing factor for clinical anastomotic leakage in patients undergoing rectal cancer resection. Quantitative measurement of radiation proctitis is needed. OBJECTIVE: This study aimed to quantitate the changes of anatomic features caused by preoperative radiotherapy for rectal cancer and evaluate its ability to predict leakage. DESIGN: It was a secondary analysis of a randomized controlled trial (NCT01211210). MRI variables were retrospectively assessed. SETTINGS: The study was conducted in the leading center of the trial, which is a tertiary GI hospital. PATIENTS: Patients undergoing preoperative chemoradiation with sphincter-preserving surgery were included. MAIN OUTCOME MEASURES: Anatomic features were measured by preradiotherapy and postradiotherapy MRI. Univariate analyses were used to identify prognostic factors. Receiver operating characteristic curves were constructed to determine the cutoff value of the changes of MRI variables in predicting leakage. RESULTS: Eighteen (14.4%) of the 125 included patients developed clinical anastomotic leakage. Baseline characteristics were comparable between leakage group and nonleakage group. Relative increments of width of presacral space, thickness of rectal wall, and distal end of sigmoid colon discriminate between the 2 groups better than random chance. Relative increments of width of presacral space was the best performing predictor, with area under the curve of 0.722, sensitivity of 66.7%, specificity of 72.0%, and positive and negative predictive value of 28.6% and 92.8%. LIMITATIONS: The study was limited by its small sample size and retrospective design. CONCLUSIONS: Increments of the width of the presacral space, thickness of rectal wall, and distal part of the sigmoid colon helps to identify individuals not at risk for clinical anastomotic leakage after rectal cancer resection. The first variable is the strongest predictor. Changes of these variables should be taken into consideration when evaluating the application of defunctioning stoma. See Video Abstract at http://links.lww.com/DCR/B23. CLINICAL TRIALS IDENTIFIER: NCT1211210. LAS FUGAS ANASTOMÓTICAS CLÍNICAS DESPUÉS DE LA RESECCIÓN DEL CÁNCER DEL RECTO PUEDEN PREDECIRSE POR LAS CARACTERÍSTICAS ANATÓMICAS PÉLVICAS EN LAS IMAGENES DE RESONANCIA MAGNÉTICA PREOPERATORIA: UN ANÁLISIS SECUNDARIO DE UN ESTUDIO CONTROLADO ALEATORIZADO:: Anteriormente demostramos que la proctitis inducida por la radiación de radioterapia preoperatoria es un factor predisponente para la fuga anastomótica clínica en pacientes sometidos a resección de cáncer rectal. Es necesaria la medición cuantitativa de la proctitis por radiación.Este estudio tuvo como objetivo cuantificar los cambios en las características anatómicas causados por la radioterapia preoperatoria para el cáncer de recto y evaluar su capacidad para predecir las fugas anastomoticas.Fue un análisis secundario de un estudio controlado aleatorio (NCT01211210). Los variables de imagines de resonancia magnetica se evaluaron retrospectivamente.Se llevó a cabo en el centro principal del estudio, que es un hospital gastrointestinal terciario.Se incluyeron pacientes sometidos a quimiorradiación preoperatoria con cirugía conservadora del esfínter.Las características anatómicas se midieron mediante imagines de resonancia magnetica previa y posterior a la radioterapia. Se utilizaron análisis univariados para identificar los factores pronósticos. Las curvas de características operativas del receptor se construyeron para determinar el valor de corte de los cambios de los variables de resonancia magnetica en la predicción de fugas.Dieciocho (14.4%) de los 125 pacientes incluidos desarrollaron fugas anastomóticas clínicas. Las características basales fueron comparables entre el grupo de fugas y el grupo de no fugas. Los incrementos relativos del ancho del espacio presacro, el grosor de la pared rectal y distal del colon sigmoide discriminan entre los dos grupos mejor que la posibilidad aleatoria. Los incrementos relativos del ancho del espacio presacro fueron el mejor pronóstico con un AUC de 0.722, sensibilidad del 66.7%, especificidad del 72.0%, valor predictivo positivo y negativo del 28.6% y 92.8%.Estaba limitado por el tamaño de muestra pequeño y el diseño retrospectivo.Los incrementos en el ancho del espacio presacro, el grosor de la pared rectal y la parte distal del colon sigmoide ayudan a identificar a las personas que no tienen riesgo de fuga anastomótica clínica después de la resección del cáncer rectal. La primera variable es el predictor más fuerte. Los cambios de estos variables deben tenerse en cuenta al evaluar la aplicación del estoma para desvio. Vea el Resumen del Video en http://links.lww.com/DCR/B23.


Assuntos
Fístula Anastomótica , Quimiorradioterapia/efeitos adversos , Colectomia , Colo Sigmoide , Imagem por Ressonância Magnética/métodos , Pelve/diagnóstico por imagem , Neoplasias Retais , Reto , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Quimiorradioterapia/métodos , Colectomia/efeitos adversos , Colectomia/métodos , Colo Sigmoide/diagnóstico por imagem , Colo Sigmoide/efeitos da radiação , Colo Sigmoide/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/efeitos adversos , Cuidados Pré-Operatórios/métodos , Prognóstico , Neoplasias Retais/diagnóstico , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Reto/diagnóstico por imagem , Reto/efeitos da radiação , Reto/cirurgia
14.
J Radiol Case Rep ; 13(3): 28-36, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31565175

RESUMO

Castleman Disease is a lymphoid disorder characterized by the presence of an enlarged or abnormal lymph node/lymphatic tissue. The disease is classified into unicentric or multicentric variants. The unicentric form is a benign disorder that is usually asymptomatic and consists of a single lymphoid mass that is predominantly located in the mediastinum, but can also rarely develop in the neck or abdomen. The multicentric type involves more than one lymphatic station and is related to the presence of type B symptoms (fevers, night sweats and weight loss), HIV/HHV8 infection and increased serum IL-6 levels. We present the case of an unusual pelvic intraperitoneal manifestation of Castleman Disease in a 52-year-old caucasian woman who showed clinical, radiological, histological and laboratory findings common to both Unicentric and Multicentric Castleman Disease.


Assuntos
Hiperplasia do Linfonodo Gigante/diagnóstico por imagem , Pelve/diagnóstico por imagem , Hiperplasia do Linfonodo Gigante/patologia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Pessoa de Meia-Idade , Pelve/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Ultrassonografia
16.
Technol Cancer Res Treat ; 18: 1533033819874788, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31510886

RESUMO

Knowledge models in radiotherapy capture the relation between patient anatomy and dosimetry to provide treatment planning guidance. When treatment schemes evolve, existing models struggle to predict accurately. We propose a case-based reasoning framework designed to handle novel anatomies that are of same type but vary beyond original training samples. A total of 105 pelvic intensity-modulated radiotherapy cases were analyzed. Eighty cases were prostate cases while the other 25 were prostate-plus-lymph-node cases. We simulated 4 scenarios: Scarce scenario, Semiscarce scenario, Semiample scenario, and Ample scenario. For the Scarce scenario, a multiple stepwise regression model was trained using 85 cases (80 prostate, 5 prostate-plus-lymph-node). The proposed workflow started with evaluating the feature novelty of new cases against 5 training prostate-plus-lymph-node cases using leverage statistic. The case database was composed of a 5-case dose atlas. Case-based dose prediction was compared against the regression model prediction using sum of squared residual. Mean sum of squared residual of case-based and regression predictions for the bladder of 13 identified outliers were 0.174 ± 0.166 and 0.459 ± 0.508, respectively (P = .0326). For the rectum, the respective mean sum of squared residuals were 0.103 ± 0.120 and 0.150 ± 0.171 for case-based and regression prediction (P = .1972). By retaining novel cases, under the Ample scenario, significant statistical improvement was observed over the Scarce scenario (P = .0398) for the bladder model. We expect that the incorporation of case-based reasoning that judiciously applies appropriate predictive models could improve overall prediction accuracy and robustness in clinical practice.


Assuntos
Modelos Teóricos , Pelve/efeitos da radiação , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada , Algoritmos , Humanos , Órgãos em Risco , Pelve/diagnóstico por imagem , Pelve/patologia , Radiometria , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem , Radioterapia de Intensidade Modulada/métodos , Reprodutibilidade dos Testes
17.
Phys Med ; 65: 181-190, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31494372

RESUMO

PURPOSE: The purpose of this study is to create an organ dose database for pediatric individuals undergoing chest, abdomen/pelvis, and head computed tomography (CT) examinations, and to report the differences in absorbed organ doses, when anatomical differences exist for pediatric patients. METHODS: The GATE Monte Carlo (MC) toolkit was used to model the GE BrightSpeed Elite CT model. The simulated scanner model was validated with the standard Computed Tomography Dose Index (CTDI) head phantom. Twelve computational models (2.1-14 years old) were used. First, contributions to effective dose and absorbed doses per CTDIvol and per 100 mAs were estimated for all organs. Then, doses per CTDIvol were correlated with patient model weight for the organs inside the scan range for chest and abdomen/pelvis protocols. Finally, effective doses per dose-length product (DLP) were estimated and compared with the conventional conversion k-factors. RESULTS: The system was validated against experimental CTDIw measurements. The doses per CTDIvol and per 100 mAs for selected organs were estimated. The magnitude of the dependency between the dose and the anatomical characteristics was calculated with the coefficient of determination at 0.5-0.7 for the internal scan organs for chest and abdomen/pelvis protocols. Finally, effective doses per DLP were compared with already published data, showing discrepancies between 13 and 29% and were correlated strongly with the total weight (R2 > 0.8) for the chest and abdomen protocols. CONCLUSIONS: Big differences in absorbed doses are reported even for patients of similar age or same gender, when anatomical differences exist on internal organs of the body.


Assuntos
Tamanho Corporal , Método de Monte Carlo , Doses de Radiação , Tomografia Computadorizada por Raios X , Abdome/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Cabeça/diagnóstico por imagem , Humanos , Masculino , Pelve/diagnóstico por imagem , Imagens de Fantasmas , Tórax/diagnóstico por imagem
18.
Int J Radiat Oncol Biol Phys ; 105(5): 1137-1150, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31505245

RESUMO

PURPOSE: Deep learning methods (DLMs) have recently been proposed to generate pseudo-CT (pCT) for magnetic resonance imaging (MRI) based dose planning. This study aims to evaluate and compare DLMs (U-Net and generative adversarial network [GAN]) using various loss functions (L2, single-scale perceptual loss [PL], multiscale PL, weighted multiscale PL) and a patch-based method (PBM). METHODS AND MATERIALS: Thirty-nine patients received a volumetric modulated arc therapy for prostate cancer (78 Gy). T2-weighted MRIs were acquired in addition to planning CTs. The pCTs were generated from the MRIs using 7 configurations: 4 GANs (L2, single-scale PL, multiscale PL, weighted multiscale PL), 2 U-Net (L2 and single-scale PL), and the PBM. The imaging endpoints were mean absolute error and mean error, in Hounsfield units, between the reference CT (CTref) and the pCT. Dose uncertainties were quantified as mean absolute differences between the dose volume histograms (DVHs) calculated from the CTref and pCT obtained by each method. Three-dimensional gamma indexes were analyzed. RESULTS: Considering the image uncertainties in the whole pelvis, GAN L2 and U-Net L2 showed the lowest mean absolute error (≤34.4 Hounsfield units). The mean errors were not different than 0 (P ≤ .05). The PBM provided the highest uncertainties. Very few DVH points differed when comparing GAN L2 or U-Net L2 DVHs and CTref DVHs (P ≤ .05). Their dose uncertainties were ≤0.6% for the prostate planning target Volume V95%, ≤0.5% for the rectum V70Gy, and ≤0.1% for the bladder V50Gy. The PBM, U-Net PL, and GAN PL presented the highest systematic dose uncertainties. The gamma pass rates were >99% for all DLMs. The mean calculation time to generate 1 pCT was 15 s for the DLMs and 62 min for the PBM. CONCLUSIONS: Generating pCT for MRI dose planning with DLMs and PBM provided low-dose uncertainties. In particular, the GAN L2 and U-Net L2 provided the lowest dose uncertainties together with a low computation time.


Assuntos
Aprendizado Profundo , Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada/métodos , Tomografia Computadorizada por Raios X/métodos , Osso e Ossos/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/efeitos da radiação , Humanos , Masculino , Pelve/diagnóstico por imagem , Pelve/efeitos da radiação , Próstata/diagnóstico por imagem , Próstata/efeitos da radiação , Dosagem Radioterapêutica , Reto/diagnóstico por imagem , Reto/efeitos da radiação , Valores de Referência , Tomografia Computadorizada por Raios X/classificação , Incerteza , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/efeitos da radiação
20.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 410-416, ago.-sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182860

RESUMO

Introducción: Existen diversas controversias respecto a las pruebas diagnósticas y tratamiento de la pubertad precoz central (PPC). El objetivo de este estudio es exponer las experiencias adquiridas en un grupo de niñas con PPC tratadas con triptorelina, analizándose las características auxológicas y pruebas diagnósticas. Materiales y métodos: Estudio observacional retrospectivo en un grupo de 60 niñas con PPC atendidas entre 2010 y 2017. Al diagnóstico se registraron datos sociodemográficos, auxológicos y hormonales, realizándose ecografía pélvica y resonancia craneal. Fueron tratadas con triptorelina, y tras su retirada fueron seguidas hasta la menarquia. Resultados: Al iniciar el tratamiento, la edad cronológica y edad ósea eran de 7,7±0,7 y 9,7±0,8 años, respectivamente (media±DE), con una velocidad de crecimiento de 8,3±1,6cm/año. La talla diana era de 161,1±5,8cm. El pico de LH tras estimulación era de 16,6±12,1 UI/l. El volumen ovárico era superior a 3 cc en el 35% de los casos. La resonancia magnética craneal fue patológica en 7 casos (11,7%). Al final del tratamiento, la edad cronológica y la edad ósea eran de 10,3±1,1 y 11,2±0,8 años, respectivamente, con una velocidad de crecimiento de 4,7±1,4cm/año. A la edad de la menarquia (11,9±0,9 años), la talla era de 157,5±5,7cm. Conclusiones: El tratamiento de la PPC con triptorelina parece resultar beneficioso. La posibilidad de bloquear el desarrollo puberal y ralentizar la maduración ósea permiten que las pacientes alcancen su talla diana. No obstante, sería preceptiva una monitorización auxológica personalizada


Introduction: There are several controversies regarding the diagnostic tests and management of central precocious puberty (CPP). The aim of this study is to present the experience acquired in a group of girls with CPP treated with triptorelin, and to analyze the auxological characteristics and diagnostic tests. Material and methods: An observational, retrospective study in a group of 60 girls with CPP was conducted between January 2010 and December 2017. Sociodemographic, auxological and hormonal data were recorded at diagnosis, and pelvic ultrasound and magnetic resonance imaging of the head were performed. Girls were treated with triptorelin and monitored after treatment discontinuation until menarche. Results: At treatment start, chronological age and bone age were 7.7±0.7 and 9.7±0.8 years respectively, and growth velocity was 8.3±1.6cm/year. Target height was 161.1±5.8cm. Peak LH level after stimulation was 16.6±12.1 IU/l. Ovarian volumes were greater than 3mL in 35% of cases. MRI of the head was pathological in seven girls (11.7%). At treatment completion, chronological age and bone age were 10.3±1.1 and 11.2±0.8 years respectively, and growth velocity was 4.7±1.4cm/year. At the age of menarche (11.9±0.9 years), height was 157.5±5.7cm. Conclusions: Treatment of CPP with triptorelin appears to be beneficial. The possibility to block pubertal development and slow skeletal maturation allows patients to reach their target height. However, individualized auxological monitoring would be mandatory


Assuntos
Humanos , Feminino , Criança , Puberdade Precoce/diagnóstico , Puberdade Precoce/tratamento farmacológico , Pamoato de Triptorrelina/administração & dosagem , Pamoato de Triptorrelina/uso terapêutico , Pelve/diagnóstico por imagem , Crânio/diagnóstico por imagem , Espectroscopia de Ressonância Magnética , Menarca/efeitos dos fármacos , Estudos Longitudinais
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA